- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $10,715.19 / $20,417.38
| Professional | | $8,511.38 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $23,442.29 / $107,151.93
| Facility | | $20,417.38 | $23,442.29 | $107,151.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $16,218.10 / $23,442.29
| Professional | | $9,772.37 | $16,218.10 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $29,512.09 / $38,904.51
| Facility | | $24,547.09 | $29,512.09 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,791.08 / $19,952.62 / $19,952.62
| Professional | | $14,791.08 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,803.84 / $15,848.93
| Facility | | $13,182.57 | $13,803.84 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $13,803.84
| Professional | | $10,000.00 | $10,000.00 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $30,199.52
| Professional | | $19,952.62 | $19,952.62 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Professional | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $23,442.29 / $107,151.93
| Facility | | $20,417.38 | $23,442.29 | $107,151.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $16,982.44 / $25,703.96
| Professional | | $9,772.37 | $16,982.44 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $14,454.40 / $26,302.68
| Facility | | $15.14 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,454.40 / $19,952.62
| Professional | | $9,332.54 | $14,454.40 | $19,952.62 |